Acne in adulthood (adult acne) is divided into persistent acne (one that started during puberty and lasts) or acne with a late onset that begins after the age of 25. Among the most frequently discussed reasons for their occurrence are reported endocrine and metabolic disorders, diet (so-called Western diet) and chronic stress. It is more common in females.
About 60% of women in Western countries continue to have acne in their 20s, and about 40% "carry" it in their 30s. The underlying genetic predisposition to the disease is evidenced by studies among families with generations suffering from acne, as well as studies among identical twins. The family history of acne is associated with an earlier onset of the disease, resistance to therapy, and a tendency to persist into adulthood.
Endocrine and metabolic disorders in adult acne
An extensive study * among 25-year-old patients with acne examined signs of hyperandrogenism (ie, dominance of male sex hormones). The scientist examined total testosterone (TT), sex hormone binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEA), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH). Out of 120 cases, clinically manifested hyperandrogenism was observed in 71.67%, while biochemical in about 18.33%. This means that in 71.67% of women there are signs of increased hair growth, male pattern baldness, overweight, but not all of them have a deviation in the lab results. The most common disease is polycystic ovary syndrome. Much more frequent complaints of irregular menstruation have been reported among patients with persistent acne.
The so-called Western diet is defined as a diet with frequent consumption of dairy products, foods with a high glycemic index and intake of fats. Foods with a high glycemic index are rapidly absorbed, increase serum glucose and stimulate glucose-dependent insulin signaling. Dairy products contain growth hormone and anabolic steroids, which increase the concentration of ILGF-1 (insulin-like growth factor 1). This growth factor stimulates the synthesis of androgens from the ovaries, but inhibits (suppresses) the hepatic synthesis of SHBG (sex hormone binding globulin). This means that the free concentration of androgens in the blood increases (bioavailability increases). Both ILGF-1 and androgens stimulate sebum production by the sebaceous glands. And this is one of the main pathogenetic causes of acne.
In brief, I would like to summarize two extremely interesting studies *. They were conducted among populations from the island of Kitava, Papua New Guinea and among hunter-gatherers Ace (as anthropologists call them) in Paraguay. As you can guess, they are not consumers of the western diet with its processed foods. Their daily menu includes mainly tubers, fruits, fish and coconut. Milk, alcohol and fat intake are reported to be minimal. Of the 1,300 people examined, no cases of acne were found. Yes, friends, so am I.
- If you have acne that persists or appears in adulthood, consult both an endocrinologist and a gynecologist.
- Pay attention to the food you eat and try to reduce processed foods and exclude sugar.
*Sardana, K., Bansal, P., Sharma, L.K., Garga, U.C. and Vats, G. (2020), A study comparing the clinical and hormonal profile of late onset and persistent acne in adult females. Int J Dermatol, 59: 428-433.
*Kucharska A, Szmurło A, Sińska B. Significance of diet in treated and untreated acne vulgaris. Postepy Dermatol Alergol. 2016;